Young Adult Cancer Survivors Hard Hit by Treatment Costs

Roxanne Nelson, RN, BSN


March 31, 2016

The nearly 14 million cancer survivors in the United States face a long list of challenges resulting from long-term and late effects of cancer therapy.[1] But increasingly, survivors face another adverse effect—financial toxicity, and young adult survivors are particularly hard hit.

"Their resources are more likely to be limited; they may be trying to finish their education, or trying to buy a house, or in danger of losing that house," said Kevin S. Baker, MD, director of the Fred Hutchinson Cancer Research Center Survivorship Program and director of the Pediatric Blood and Marrow Transplant at Seattle Cancer Care Alliance.

Young adult survivors face challenges that differ dramatically from those of survivors of childhood and late age-onset cancers.[2,3] Dr Baker, who was lead author of a study presented at the Cancer Survivorship Symposium,[4] spoke to Medscape about the financial challenges faced by young adult cancer survivors.

"Unlike older adults, [young adults] tend to be less established financially or in a career," Dr Baker said. "A 65-year-old, for example, may already own a home and may be getting ready to retire, and have assets."

In the case of childhood cancer survivors, economic challenges tend to affect the patient's family more directly than the patient. "The cancer experience becomes part of a more distant past, and the financial aspect doesn't affect them in the same way as it would a young adult who is unable to work or to even afford care," Dr Baker said.

For young adults, cancer and its costs strike at a particularly vulnerable time in their lives.

Young Adult Survivors Constitute a Distinct Group

Cancer among adolescents and young adults is being increasingly recognized as a subspecialty that is distinguishable from pediatric and adult oncology in several ways, including incidence, types of tumor, psychosocial characteristics, healthcare needs, and financial burden.[5,6]

The age parameters used to comprise this group vary, but are generally defined as from age 15 years up to age 39 years. Overall, cancer is rare in adolescents and young adults, but it is the leading cause of death in this age group after accidental injury, homicide, poisoning, and suicide.[6,7] Approximately 1 million new cases of cancer are diagnosed worldwide among 15- to 39-year-olds, including about 70,000 individuals in the United States. This accounts for about 5% of the US cancer diagnoses, which is six times the number of cancer diagnoses in children aged 0-14 years.[7]

The 5-year survival rate of young adult patients is about 80%, although many are at risk of developing chronic health conditions stemming from chemotherapy, radiation, and surgery received during treatment. Dr Baker noted that many of the patients in this age range still have a high incidence of pediatric-type cancers, and thus are potentially at risk for late effects because of the highly aggressive nature of many of the treatment regimens.

"They still have a pretty high incidence of the typical pediatric types of cancer that are treated very aggressively, and because they are younger, most don't have other health issues that limit their ability to receive this level of treatment," said Dr Baker. These patients are usually treated more aggressively than older adults, in whom chemotherapy may be modified, given in less intensive regimens, or not given at all, he explained.

Although adolescent cancer patients have often been included in studies of childhood cancer survivors, those in the upper age range are underrepresented in the survivorship literature.


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